| Certificate Number | 940 | | Date Issued |
| Child Given Name | Auerla Dennis |
Raff | Child Surname |
| Child Sex | Male |
W | Child Race |
| Date of Birth | 23 Apr 1884 |
Ames Story Co IA | Place of Birth |
| Father's Given Name | Chas Francis |
Raff | Father's Surname |
| Father's Occupation | Farmer | American | Father's Nationality |
| Father's Birth Place | Ohio | 28 | Father's Age |
| Mother's Given Name | Lovina | Eastwood | Mother's Maiden Name |
| Mother's Surname | Raff | Ames Story Co IA | Mother's Residence |
| Mother's Nationality | American | Indiana | Mother's Birth Place |
| Mother's Age | 24 | 3 | Number of Child This Mother |
| Medical Attendant's Name | E.B. Plumb | Ames IA | Medical Attendant's Address |
| Certificate Signer's Name | E.B. Plumb | Ames IA | Certificate Signer's Address |
| Returned by Name | E.B. Plumb | | |